Health Psychology

• What two models can be used to explain the association between socioeconomic status and health?

  Social Causation Model

  Social Drift model
• What does the Social Causation model suggest?

  Condition of poverty causes mental health disorders through financial stress, decreased social capital, increased exposure to poor living conditions, and unhealthy behaviors
• What does the Social Drift model propose?

  Goldberg 1963

  This model suggests that individuals with mental health disorders tend to experience a downward shift in their socioeconomic status. In other words, rather than low socioeconomic status causing mental health problems, the model proposes that mental health problems cause individuals to drift into lower socioeconomic statuses over time.
• What can you tell me about life expectancy?

  Measured in ‘full health years’ (i.e. years in ‘good’ health)

  • Overall, richer countries have longer-lived populations with more ‘full health’ yearsDifferences between rich and poor countries may be due to a number of factorsDifferences between rich and poor within countries• The Registrar General’s social scale – job type is used as a proxy measure of income.Divides jobs into a number of income categories.o Healthy life expectancy falls as wealth decreases
• What is the Preston Curve (2007)


  Describes relationship between national income and life expectancy. As one increases the other increases
• Which is better the Social Drift or Social Causation model

  Smith and Stansfield (1991)

  • Baseline Social Economic Status predicted later health status
  • Measure of health status predicted Social Economic status less strongly
  • Therefore, Social economic status can be seen as a cause of health status rather than a consequence
• Part 2 - Which is better the Social Drift or Social Causation Model?

  Ferrie et al. (2001)

  • People move from employment to unemploymentment health deteriorates becoming poor is damaging to health
• Stage models


  Models where there may be qualitatively different stages in the initiation and maintenance of health behaviour, where different cognitions may be important at different stages
• A stage theory


  • A classification system to define stages
  • Ordering of stages
  • Common barriers to change facing people within same stage
  • Different barriers to change facing people in different stages
• The Transtheoretical Model (TTM)


  A stage model that makes 2 broad assumptions: i) people move through stages of change, and ii) the processes involved at each stage differ
• Stages in the TTM

  • Pre-contemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
  • Termination
  • Relapse
• Processes involved in moving from one stage to the next in the TTM

  • Decisional balance: The pros and cons of changing
  • Self-efficacy: Confidence in overcoming temptations and doing the behaviour
  • Processes of change: The things people do to progress (Experiential processes, Behavioural processes)
• Precaution Adoption Process Model


  A stage model designed to model uptake of precautionary/protective behaviours, with a more differentiated stage structure than the TTM
• Stages in the Precaution Adoption Process Model


  • Unaware
  • Unengaged
  • Deciding about acting
  • Decided not to act
  • Decided to act
  • Acting
  • Maintenance
• Continuum models


  Models where perceptions or beliefs are used in combination to predict where an individual will lie on an outcome continuum (such as an intention or behaviour), rather than being at 'discrete ordered stages'
• Theory of Planned Behaviour (TPB)


  A continuum model where intention to act is derived from: attitudes, norms, and perceived behavioural control
• The TPB was developed from the earlier Theory of Reasoned Action (TRA)
• Meta-analyses have provided empirical support for the TRA and TPB, showing they can account for a substantial proportion of the variance in intention and behaviour
• Limitations of the TPB include that it predicts intentions better than behaviour, and other factors like moral norms, anticipatory regret, self-identity, implementation intentions, and self-efficacy versus perceived behavioural control can help transform an intention into action
• Goal priority may be important for carrying through an intention, as health behaviours occur within a milieu of ongoing activities and goals need to be prioritised
• Affective attitudes (feelings) are better predictors of intention and behaviour than instrumental (cognitive) attitudes
• Social Determinants of Health

  Health behaviour in context
• This session looks at the context in which health behaviour motivation and coping adjustments occur
• The essential point is that people exist within a wider social/situational milieu, and this influences people's health and their health-related behaviours
• Life expectancy


  Measured in 'full health years' (i.e. years in 'good' health)
• Overall, richer countries have longer-lived populations with more 'full health' years
• Differences between rich and poor countries may be due to a number of factors
• Registrar General's social scale


  Job type is used as a proxy measure of income, dividing jobs into a number of income categories
• Healthy life expectancy falls as wealth decreases
• Marmot, Davey-Smith & Stansfeld (1991), Ferrie et al (2001), Hoffman, Kroger and Geyer (2019), Austin et al (2018) find support for Social Causation Model
• Possible Mechanisms


  • Health Behaviours: Differences between SES groups and engagement in 'risky' and 'healthy' behaviours
  • Environment: Poorer living conditions - Renting vs. owner-occupying
  • Stress: Low SES may be associated with increased levels of stress, which damages health
  • Social Capital: Wide disparity in wealth distribution is associated with lower social capital (i.e. less social cohesion)
  • Effective Coping: Chen and Miller (2012) argue that children who develop a Shift-and-Persist (S-P) approach to dealing with SES related stress are less likely to develop SES-related poorer health later in life
• Graham (1994), Oncken et al (2015) show differences in health behaviours are not due to lack of knowledge
• Scarcity Hypothesis


  Shah et al (2012) [for summary, see Fell and Hewstone, 2015 in Readings list]
• Marmot et al (1984) 'Whitehall Study' showed that occupational status predicted health independently of lifestyle behaviours
• Kivimäki et al (2007) found SES and behaviour were independently associated with coronary heart disease
• Poorer living conditions - Renting vs. owner-occupying, individuals in low SES groups may be exposed to health-damaging environments
• Health deleterious effects of renting may be due to lower control (Macintyre & Ellaway, 1998)
• Carroll, Davey-Smith & Bennett (1996) highlight lifetime sources of stress for those in SES groups
• Karasek & Theorell (1990) low SES jobs tend to be those with high demands and low autonomy (and possibly lower social support), leading to increased likelihood of job strain and increased stress
• Wide disparity in wealth distribution is associated with lower social capital (i.e. less social cohesion), leading to increased stress and stress-related illness (Wilkinson 1990, 1992, 2010; Forwell 1993; Uphoff et al 2013)